All Entries in the "Physician performance" Category
Hospitalist with a capital “H”
By Richard Rohr, MD, MMM, FACP, FHM
I worry a bit about the self confidence of recently trained hospitalists. When I started my first program, it was in a small hospital that had a good range of consultants, but most of them were located primarily at larger hospitals and were not always available for immediate consultation. Under those circumstances, we stretched ourselves a bit and handled a wide variety of problems, including critical care, on our own.
I consider myself an Internist with a capital I, because I am willing to manage all types of adult medical problems, with judicious use of consultants and liberal use of references such as UpToDate. Some physicians enjoy practicing in rural areas because it gives them the opportunity to use skills and perform procedures that are reserved for subspecialists in urban areas. I spent a year in a rural hospital with hardly any consultants but still managed to care for a lot of problems on my own.
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Contest winner: OPPE forms simplified
Thanks to Sharon Chaput, RN, CSHA, director of regulatory and quality management at Brattleboro Retreat in Brattleboro, VT for sending in this OPPE indicator form and OPPE master grid. We here at HCPro have heard for several years now how tricky it can be to measure physician performance, so we’re happy to share these forms, which can be adapted to meet the needs of any specialty.
“The Joint Commission surveyor told us this past June that this form is the best he has seen in the country,” Chaput writes.
Heads up: Physicians are people, too
Two new studies support mysterious rumors that doctors are people, too. According to a study in the Sept. 23/30 issue of JAMA, fatigue isn’t the only factor that increases the likelihood that a physician will make a medical error. Other factors, such as financial and familial distress, also contribute. When developing a burnout prevention program, it is important to separate fatigue from other stress factors, the study suggests.
On a similar note, another study in the same issue of JAMA says that meditation may help relieve symptoms of burnout caused by fatigue and personal problems, as well as improve physicians’ relationships with patients. Physicians who participated in a mindful communication education program demonstrated sustained improvements in well-being, and their attitudes associated with patient-centered care improved.
Contest entry: Physician hotline for patient and physician satisfaction
Keeping patients and physicians happy sometimes requires some creative thinking. We liked this tip that came from Gloria Ziegler, CPCS, medical staff services director of Val Verde Regional Medical Center.
Gloria says that her institution strives to improve patient and physician satisfaction. How do they accomplish that goal?
The Val Verde Regional Medical Center currently uses a physician hotline for physicians to call reference any complaints, praises, or new ideas that might be helpful in improving patient/physician satisfaction.
She says,
“We also have established a patient/customer hot line to deal with any concerns that our community might have dealing with their care at our facility. Our administration works extra hard to assure that anyone having concerns or issues which need to be resolved are addressed in a timely manner. We are the only facility in town within a 300-mile radius and must work extra hard to keep our patients from going to San Antonio or San Angelo for care.”
Thanks for sharing!
Keep those contest entries coming, and you could win the free registration to The Greeley Medical Staff Institute Symposium (Nov. 8-9, Naples, Fl)!
We’ll share the entries on the blog and select the best one at the end of the month.
To enter the drawing, submit your best practice, tool, or tip to us. Find more details here!
Are concierge hospitalists coming?
I recently had the opportunity to have lunch with a member of the board of directors of a company called MDVIP and was fascinated by their business model. MDVIP helps primary care physicians transition from a traditional practice model to a concierge practice. This company was featured in a recent article on CNNmoney.com.
Here are some of the basics of MDVIP as I understand them:
- The patient pays an annual retainer of approx. $1,500 or $125 per month
- The practice limits the number of patients to between 300—600
- The physician is accessible to any patient around the clock by cell phone and will even meet the patient in the emergency room when an emergency arises
- The patient keeps his or her health insurance in place
- The patient must take an annual “Mayo Clinic” level physical, and the practice focuses on wellness and prevention
Contest winner: Physician report card tool
Source: TOPS Surgical Specialty Hospital, Houston, TX.
Congratulations to Nancy Bertling, RN, MBA, quality manager of TOPS Surgical Specialty Hospital in Houston, TX! Nancy is the July winner for the Greeley Medical Staff Institute Symposium giveaway for two free seats at the Nov. 8-9 seminar in Naples, Fl.
Nancy submitted a report card for quality and re-credentialing that keeps track of physician activity. This tool is also used in dashboards for quality and peer review.
You can download the physician report card here. Thanks for sharing, Nancy!
To all the readers, you can still submit your entry for next month’s contest. Find details here. Keep those entries coming, and good luck!
For the latest related news and updates on the conference, click on the tag “Greeley Medical Staff Institute Symposium.”
Karen M. Cheung
Associate editor
Is gainsharing in sight?
The July issue of Today’s Hospitalist includes a very interesting Q&A session with Andrew Knoll, MD, JD, on the topic of gainsharing. The article centers on an opinion issued by the Office of Inspector General (OIG) last fall that perhaps indicates a relaxed future view of gainsharing. I believe this is an idea whose time has come. Many hospitalists have long been frustrated that the financial benefits of their hard work in improving the efficiency and quality of care have largely been enjoyed by the hospitals in which they serve.
The OIG opinion was favorable toward a hospital that shared a pay-for-performance bonus (received from an insurer) with its medical staff members. The bonus was paid for achieving quality improvement goals though the exact goals were was not disclosed. This is potentially good news for hospitalists, but we should remain cautious with our optimism.
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Hospitalists are efficient diagnosticians, study says
We've known for years that hospitalist care cuts down on length of stay, but what about diagnostics and throughput?
Patients under hospitalist care, particularly intensivist care, experienced shorter length of stay and reduction in testing than teaching teams, according to a new study, “Determinants of Hospitalist Efficiency: A Qualitative and Quantitative Study,” published in the June issue of Medical Care Research and Review. Researchers also found that hospitalists are efficient diagnosticians and enhance throughput.
Although the study demonstrated the benefits hospitalists provide, it also showed little evidence that they are more focused on quality or use community resources better than non-hospitalist providers.
Do you know of any new studies that evaulate hospitalist care on overall patient quality and hospital revenue?
Free form: Stages of hospitalist leadership transition
As the ranks of hospital medicine continue to swell, the need for leadership development is becoming increasingly important. Much like an airplane without a pilot, a hospital medicine group without strong and well-trained leaders is bound to implode and fail in its mission. Leadership development is an especially big challenge for hospital medicine–a subspecialty with a large proportion of relatively young physicians thrust into positions traditionally reserved for more experienced individuals. Nevertheless, hospitalists are in a unique position to establish themselves as forward-thinking practitioners laying the found for medical leadership.
The leadership transition from hospitalist to hospitalist leader generally occurs in five predictable stages of unpredictable duration. Those stages are:
Why teaching bedside skills to hospitalists is in decline
Only 17% of hospitalist teaching time is spent at the patient’s bedside, according to a new study “Quantification of Bedside Teaching by an Academic Hospitalist Group,” published in the May/June 2009 issue of the Journal of Hospital Medicine.
Conducted at the Brigham and Women’s Hospitalist Service in Boston, the study asked residents and interns how much time hospitalist attending physicians spend at the bedside and how much they teach physical examination skills. The academic hospital found that hospitalists spend an average of 17 minutes inside patient rooms during rounds, which translates to only 17% of their teaching time spent at the bedside.
Live from SHM: Do administrators need to clock clinic time?
Patrick J. Cawley, MD, FHM, talks about the role of the hospitalist in the C-suite. (Photo/Karen M. Cheung)
The three hospitalist leaders on the SHM panel for the session, “Hospitalists in the C-suite,” had different answers to the question, “Do administrators need to do clinical work?”
In the case of Michael Ruhlen, MD, MHCM, FHM, vice president and chief medical officer for Carolinas Medical Center, his role does not include clinical time. He decided, after practicing in pediatrics, to fully commit to his other administrative duties, although the two other administrators on the panel still practice clinical work.
There isn’t a universally defined role for the administrator, such as a chief medical officer, which makes the number of clinic hours—if any—a difficult one to pinpoint as a universally accepted standard.
“It’s hard to say what your job description is because there are many views of what it is,” said David Edwards, MD, chief medical officer at Banner Gateway Medical Center in Mesa, Az.
SHM President Patrick J. Cawley, MD, FHM, chief medical officer at Medical University of South Carolina in Charleston, SC, added, “When you see one CMO, you’ve seen one CMO,” he joked.
Cawley, who practices about 10 weeks per year among his many other duties, says that CMOs absolutely needs to do clinical work.
Edwards admits he doesn’t practice as much these days, although he is trying to return to pick up more clinical work. Clinical work can give administrators the credibility they need, he said.
Live from SHM: Is there a glass ceiling between hospitalists and the C-suite?
Patrick J. Cawley, MD, FHM, talks about the role of the hospitalist in the C-suite. (Photo/Karen M. Cheung)
The majority of CEOs are not physicians, said SHM President Patrick J. Cawley, MD, FHM, chief medical officer at Medical University of South Carolina in Charleston, SC. on Friday morning at a session titled, “Hospital of the Future: Hospitalists in the C-Suite.”
Cawley posed an interested question—Is there a glass ceiling between hospitalists and the C-suite of CEOs, CMOs, COOs, etc.? What does the current numbers of MDs in the C-suite suggest about attaining those high-executive-level positions?
It seems to me that the answer is that there isn’t a glass ceiling if you don’t want there to be. Hospitalists are in the unique position to take on the leadership role of administrator because they are embedded in the system processes of the hospital. They are “real-time hospitalists,” said David Edwards, MD, chief medical officer at Banner Gateway Medical Center in Mesa, Az. They are physicians in the trenches, giving them the best advantage of creditability since they have practiced medicine themselves, said Edwards.
Michael Ruhlen, MD, MHCM, FHM, speaks about his role as a administrator-clinican. (Photo/Karen M. Cheung)
A more appropriate question to ask is “Do you want to be administrator?” When asked why he does administrative work, Michael Ruhlen, MD, MHCM, FHM, vice president and chief medical officer for Carolinas Medical Center joked that he had no idea why, although he admits all his duties are still fun.
